Patient Experiences Radiotherapy Treatment Mask

Lisa Laws (00:04):

Thank you, everybody. So we’re sort of at the Rosemary Cancer Center just at the beginning of our journey for open face masks. So part of your evidence to go towards an open face mask is usually the feeling of the therapist. And we want to catch up with everybody else. We want to implement faceless masks because we’ve done every other site. But actually, the evidence from your patients to move on to those faceless masks is particularly important. So, just a bit of background from my center. We’re in the northwest of England. We have a patient population of 1.6 million. We treat up to about 240 patients a day. We’ve got about 90 radiographers. We are very fortunate. We have AlignRT on all eight of our linacs and both of our Philips scanners as they’re all paid for by our charity. We’re currently using SGRT for a plethora of indications, but where we’re at now is that we’re currently evaluating open face mask for the brain and looking at different vendors for our head and necks.

Lisa Laws (01:03):

But what we wanted to do was get the patient’s evidence to support moving forward. So the background of it really, there’s an increased use of SGRT, which allows us to adapt our immobilization for our patient comfort. There are several types of open-face masks on the market. There are recent studies, including a study by Malone Et al, which have looked at the reproducibility between the two different masks. And their findings have given us the confidence to explore introducing them at the Rosemary Cancer Center. And I’ll catch Kiran presentation tomorrow on that. The emotional distress that as radiographers we see from our patients, and them having to have interventions such as medication or not even having the treatment at all. And the stories that radiographers give you of being unable to treat a patient with an immobilization mask because it is a closed face mask.

Lisa Laws (01:54):

So the aims of the studies gain an understanding of how the patients feel about those masks. And did they need any assistance during the treatment to tolerate them? What were the patient’s feelings in the beginning? What were the patients feeling as they went on with their treatments? Would they prefer an open face mask, and would they actually be willing to travel to another center for that open face mask? And given a choice, we gave them an indication of the different base masks on the market. Which one would they ultimately prefer? So the design was, it was a peer review questionnaire which was initially sent out at a conference for swallows. I’ll explain who they are after. And it was also done online with a QR code. And it was a mixture of closed and open questions. There was free text boxes so the patient could give us that extra bit of information that we didn’t have.

Lisa Laws (02:42):

The questions we used were used a rating scale to be able to analyze them. The sample of patients who completed the questionnaire, it was in the community. They attended the Swallows charity group and some were in active treatment and some had finished treatment, and it for a different number of years. So just a bit of a background about the swells group, because they did do all the hard work for us. It’s a head and neck cancer charity set up by patients to support patients. And there’s support countries across the groups across the country, excuse me. And it’s access for patients who’ve completed the radiotherapy pathway, but also some patients who are on active treatment. So just to give you a bit of a background of the types of patients that completed the questionnaire, of 85% of those patients that completed it at had four to six weeks of treatment, which is quite standard.

Lisa Laws (03:34):

The range of years it was patients treated between 1999 and 2023. 85% of those patients were open sorry, were closed face mask. And the age range was between 26 years old and 81. So, quite a broad range of patients to be able to conduct this questionnaire on. And these were the centers. I was quite surprised when I looked. I don’t know where Washington DC came in. I’m assuming it’s someone who had had treatment and had come over to this country and immigrated. But it’s quite a broad range of centers that this information came from. So the total, there was 101 participants. And as I said, summary inactive treatment and some of the treatment had been completed. So it was quite a good sample to be able to get an idea of what patients thought about the closed face mask. So one of the first questions is, did the patients feel fine about wearing the mask when they were informed of it? So overwhelmingly, some were a bit neutral, and I think some of that is forgetting about the treatment and forgetting about at the very beginning of treatment, how they felt. But the patients with a definitive answer, 48% of them, didn’t disagree that they felt okay about the mask. And it is quite daunting for the patients to wear a mask for treatment.

Lisa Laws (04:51):

How comfortable do the patients feel wearing the mask? So it ranged from one to four being comfortable and five to 10 being less comfortable. And that’s quite damning evidence. 72% of those patients weren’t comfortable wearing that mask at all. Is that done? And were the patients able to relax while wearing the mask during treatments? You would think that as treatment went along, people would say, yeah, actually, it feels a bit better wearing that mask. I’m used to it now, but there is people who, are neutral, but the greatest proportion of patients that the people with a definitive answer said that they disagreed strongly, and were able to relax. And that’s quite important. We want our patients to have a nice experience during treatment. So this, this question was quite a positive answer. The mask didn’t cause any pain during treatment. So 69% what you don’t want for your patients to be in pain.

Lisa Laws (05:46):

And you look at those close face masks and you think they must be quite in pain, especially when they have swelling or they’re having problems during the treatment eating and swallowing. But actually it’s quite as a radiography, it’s quite nice to see that it’s not causing the patients any pain. But yes, we can improve on that with an open face mask. So did the patients feeling changed towards the mask during treatment? So actually quite a large proportion of patients said yes, I was able to cope better. But you’ve got to look a little bit more into that. Is that the loyalty to the radiographers? Is that that because Yes, I felt better because I had to have the mask and it’s been instilled into them, you must have this mask, it will keep you still, we have to be very accurate with treatment. So actually they just got on with it and actually felt like it became easier. Or actually, was that a feeling they had?

Lisa Laws (06:38):

So we did question our patients on did they needed any support techniques to help with relaxation. 58% of patients, quite a big proportion of patients that need some sort of intervention and actually music breath work, you know, they’re, they’re not invasive. They don’t impede the patient at all. But medication, how many of our patients drive for the treatment and we’re having to give them medications to get them for the treatment and then they’ve got to get home afterwards. It’s not ideal. We don’t want to be giving patients medication just to be able to get through their treatments. And we have a quote from a patient there that said if their aunt had a mild case before each session because of claustrophobic, they wouldn’t have got through it. So what can we do to prevent having to put those interventions in place?

Lisa Laws (07:27):

So we then sort of went through what other experiences did the patients have? And yes, there are some patients who had mild anxiety, mild stress, any anxiety, stress, panic, claustrophobia, or discomfort. We don’t want any of that. What we’d like is those graphs to be minimal. But we did find that quite a large proportion of our patients had moderate unpleasant experiences. So if we can improve that in any way, that was more evidence to be able to move to an open face mask. So these were the masks in question in the questionnaires. There was the closed head and neck, the closed head, open head and neck, head and shoulders, open head and chinstrap. Now, when I saw the chin strap, I was like, Ooh, but now I’ve listened to the fact that people are actually introducing no mask. I’m like, oh, could we go there?

Lisa Laws (08:15):

But let’s just get to our open face mask first. So we asked the patients, looking at those, which ones would you prefer? So the least preferred was the closed mask. So actually they’ve thought about it afterwards. And actually I, I didn’t want that closed mask. I had it because I had to have it. And the ones in active treatment, we even say, I don’t like the closed face mask. But actually, if you look at the most preferred mask, it was the open face mask. So again, that’s giving us the evidence. This is what the patients want to improve their experience. And then we, this was an interesting question because obviously in this country, everybody in the UK, sorry, everybody goes to their local department. But if you were given a choice, would you have an open face mask and would you be willing to travel?

Lisa Laws (09:01):

And that’s quite overwhelming. I would’ve thought people would be like, no, it’s all right. I’ll just stick with where I am, my local department. But actually, people would want an open face mask. And we did ask them, how far would you be willing to travel? And I was quite surprised at that. We got a quite a range of answers. But 19.5 extra miles just for that comfort just to feel, have a better experience. I wouldn’t have thought that’s where that would come out. But actually, people are willing to travel. So we sort of we did say we had some open questions and free text. So I just thought with theme, some of the things that came out from that about how the patients felt a, about the closed face mask and why they would want an open face mask. So there are some words that pop out at you straight away, uncomfortable, irritating, claustrophobic discomfort.

Lisa Laws (09:51):

It’s not a nice thing to read that you’ve had to put patients through that. And then there are quite a few quite strong words in these comments. Fear, my fear of breathing, wearing a closed face mask, the fear of being the feeling of being restricted, the fear of vomiting. The mask was tight; it chaffed my skin. And then the last one, for me personally, an open face mask would not have been an issue. I wouldn’t have had to have the active. So it’s actually all this evidence from those patients is indicating, actually, they would’ve all preferred an open face mask if that had been a possibility. But I think that was quite shocking to see the word fear. You wouldn’t want any patients to go through that. So that gave us more evidence to support going to that open face mask.

Lisa Laws (10:34):

And I sort of mentioned this point before, but if you knew another if you knew an open face mask was available in another center, would you have asked your doctor for it? There is some people that are unsure. It’s quite a large amount, but if you look at the people with the definitive answer, yes, they would’ve gone to another center. So rather than making those patients travel, let’s just provide it in the centers where we are. So the last thing we did is was just to get all the comments. So, see if we can theme them. And what were the themes? Mask experience. Some patients prefer the open face mask for comfort and reduced claustrophobia. The others felt the full mask provides security. But is that, because we’ve said to them, this treatment’s more accurate,  because you’ve got a closed face mask, you have to put up with it.

Lisa Laws (11:21):

I’m sorry, it’s uncomfortable, but that’s the best way to give you the treatment. I don’t think I’d cope particularly well with a closed face mask and being strapped to the bed. Yes, you still would be, but the openness would reduce that claustrophobia. And things like comfort issues, the tightness, could you go to just an open brain mask so there’s no tightness around the shoulders. And then the tightness of the mask. If you went to an open brain mask when his weight changes, it wouldn’t cause you problems with setting the patient up, because you’ve got the postural video. Obviously, that’s obviously not coming from the patients. That’s me. But then, psychologically coping with fear, that word comes up again. Some patients described it as terrifying, but they learn to cope. They shouldn’t have to learn to cope, they shouldn’t have to have the interventions just to be able to get through treatments.

Lisa Laws (12:09):

They did all accept it over time, but that’s because we’d instilled that in them. You need to have this mask treatment. And then there were a few other interesting comments that just came out. The survey, need for pre-treatment orientation, patients suggested walkthroughs, videos, mask demonstrations. I know in our department we do open days where we can show our patients this is what treatment’s going to be. But imagine showing them the masks, but actually thinking this mask isn’t going to scare them. It’s open, they’re going to feel better about the treatment. And then just some clear explanations why masks is necessary. When we went, when we go to the open face mask, they’ve had an understanding they have to have this closed one. We’ve instilled it in them when we go to an open one, being able to say to them, we have trialled this, we can still be as accurate because some of them will know people who have had treatment.

Lisa Laws (12:58):

And then just the role of the staff. Positive interactions with the radiotherapy teams. This is something the patient cited as crucial for corp. Physical challenges. We all know patients, mucus buildup, difficulty swallowing, related pain when lying down. And that all makes wearing the mask harder. So if we can alleviate that in some way by changing our immobilization, that’s ideal. Fewer masks would prevent the burning skin and pressure discomfort that some patients experienced. Travel burden. Now we did a, I did, I did show you a slide that said patients be willing to travel, but actually if we’ve got the open face mask in our department, they wouldn’t have to travel. Some of them would consider it, but let’s take that away. They don’t have to consider it. And then the last few comments from the patients was just most more personalised masks.

Lisa Laws (13:47):

But this is where it comes in with all those different options. Chinstrap, no mask, open face, mask, open brain open head and shoulders, having those options be able to provide to our patients. And open face masks options for those who didn’t like being disclosed. That’s all our patient comments. That all support moving to an open face mask. So our conclusion was there was a consensus for immobilization options. Some patients did prefer the chin strap, but actually the majority of the patients preferred the open face mask, head and shoulders when we gave them those options. And some, one of the conclusions that I did come from this was a positive result that the patients are not in pain during the treatment. A negative point is though the number of patients who required support, including medication, can be something that can be improved for our patients. So some further development we’d like to do is considering the emotional and psychological effect of being on treatments versus pulse treatment. And how has that affected the responses we collected? So looking at it at a more granular level, why did they, I’ve gone into it a little bit, that patients responded

Lisa Laws (14:50):

In a way, because the radiographers told them they had to have a mask. But actually, could we look at that a bit further, collect some data from patients that are right in the middle of the treatment as opposed to at the end or when they finished treatment, just to see what, how that affects their answers. And that’s it. Thank you for listening.